When Your Work Spirals Out of Control …

It’s time to change your business model

The Downward Spiral
Alas, over the past several years, Dr. Harrow’s service deteriorated. Sometimes we would phone in to get a prescription renewed and we’d get no return call. Or the line was busy. It got to the point where I would have to walk over to his office and physically hand the pill bottle to one of the office personnel who would arrange to call it into Rite-Aid.

I started resenting him. We’d make an appointment and then wind up sitting in the crowded waiting room for an hour or more.

However, since he is one of the very best in the world-recognized regularly in Philadelphia Magazine‘s Top Docs issue-we didn’t want to start all over again with a new doctor, so we put up with the inconveniences.

The New Concierge or “Boutique Medical Practice”
What triggered this column was Jerald Winakur’s Wall Street Journal Story, “‘Concierge’ Medicine, ObamaCare and the End of Empathy.”

Other stories in my archive: “For a Retainer, Lavish Care by ‘Boutique Doctors'” and “Some Doctors Downsizing to Improve Care.”

Early last spring, Peggy made a doctor’s appointment and an associate in Dr. Harrow’s office alerted her that his practice would be changing over to a “concierge practice.” A direct mail information packet and an invitation to a live presentation would follow.

A Highly Personal, Wrenching Encounter
Last May 17, 100-or-so patients of Dr. Harrow assembled in a small hospital auditorium. After the introductions, Dr. Harrow took the lectern. He looked emotionally and physically drained and frankly admitted it. Among the revelations:

  • While he had a staff of nurses, other M.D.s, assistants and office personnel, his practice had grown to 3,000 patients and he knew that was he not serving any of them well. This was not the kind of medicine he signed up for when he went to medical school.
  • The reporting system required by the hospital health system is overwhelming. He would get home at 6 or 7 p.m. and start transcribing notes during dinner and work until midnight and beyond, sometimes getting up at four in the morning to finish up.
  • Many weekends and some evenings were taken up with the sports teams. Basically he had no life.
  • In addition, many physicians these days who send their patients to the hospital, simply hand them off to the resident staff. “I have always believed that if a patient of mine is in the hospital,” Harrow told us, “I want to be there on a regular basis just to make sure everything is okay and the patient is receiving the best of care.”
  • The object of this concierge scheme was to get his caseload down to 400 patients. Harrow hoped to be able to schedule eight patients a day. For those patients in his practice that decided not to sign on to the concierge service, he would staff up with additional physicians and support personnel to make the rest of the practice smoother.
  • What if he were on the sidelines of sports event and a concierge patient needed him? “You’ll have my cellphone number,” he said. Other physicians in the practice would cover for him just as he would cover for them when they are away.
  • In short, the current system was eating him alive. He had to do something.

What the concierge service offers:

Denny Hatch is the author of six books on marketing and four novels, and is a direct marketing writer, designer and consultant. His latest book is “Write Everything Right!” Visit him at dennyhatch.com.

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  • Peter Hochstein

    Unfortunately, Denny, you’ve put your finger on what is about to emerge as a major healthcare problem: concierge medicine for those who can afford it, second class medicine for everyone else.

    One of the reasons it’s foolish to cut Medicare reimbursements is that low medicare and other insurance reimbursements drive doctors out of the Medicare orbit, or forces them to take so many patients that they can’t provide first class medicine. If anything, reimbursements to physicians and certain other providers should be increased. Funding this is problematical unless we accepted that higher taxes replace expensive out-of-pocket costs and insurance costs for healthcare – for patients and their employers alike.

    Another thing we ought to be doing is encouraging more bright young people to enter the medical profession, rather than spending their lives moving money around to make a living. Too many young people go into banking only because it’s the surest way to know they’ll be able to pay off their huge college loans quickly .

    In countries where university tuition is free, or close to it, there are fewer problems turning out the doctors, scientists and great teachers they need in adequate numbers. Meanwhile, our nation grumps about taxes and slides ever more quickly toward third world status. In fact, in some respects we’re there already.

    Sorry to go off on this rant. But concierge medicine isn’t just a marketing invention. It’s a response to a system that doesn’t reimburse its doctors fairly, and that plunges young people into decades of debt before they ever emerge with their degrees.

  • Scott Wheatley

    I’m Canadian, and though our system is not perfect I know that if I were to have a heart attack right now that within minutes I would have paramedics, a firetruck manned by trained first responders plus our office first aid attendant(certified first aid attendant) at my side.

    I would be rushed to emergancy, be served by a team of er physcians, state of the art equipment and would have a bed and 24 hour assistance by a team of well trained doctors and nurses.

    I have seen our system in action and although it isn’t perfect, I have never seen it fail in a time of extreme need.

    My cost? Between my work and my wifes it is 100% covered. If I was paying myself for a family of four it is about $200 per month. In my youth when I was to busy having fun to worry about paying provincial health premiums I was still covered.

    When I hear about some of the horror stories south of the border I can only be thankful for our system.

  • Peter

    To add to Scott’s praise for the Canadian (single-payer) system, Canadians enjoy longer life-spans (in comparison with the States), lower infant mortality, and other medical advantages … all for a fraction of the percent of GDP that Americans pay. And no one loses their home to pay for medical care.

    It’s no wonder that Ontario had to go to a higher-tech health card: It was discovered that thousands more cards had been issued than the population of the province at the time. (The extra cards were all in the hands of folks who lived in places like Buffalo and Detroit, and were happy to take advantage of Canadian healthcare: The bogus cards were said to have a "street value" of $5,000!)

    One other benefit of a single-payer system: Much lower administration costs for the doctors. The clinic where my doctor practices boasts 4 physicians. They have a grand total of 2 admin staff, to answer phones, make appointments, handle referrals, and perform all "billing"-related tasks

    As Scott says, the system isn’t perfect, but I don’t know a single Canadian who’d prefer the U.S. medical system..

  • jonathanblaine

    As a dual-citizen, born in Canada but with 20 years of navigating the wonders of the US healthcare system under my belt, here are my my 2 kopeks worth concerning US healthcare and how it measures up with other countries’ offerings.

    I address much of this in July’s "Single Payer: A $1 Trillion-savings US Health Care Pipe Dream?"

    Economically, ‘ObamaCare’ must be just the beginning. Healthcare is a necessary service, rather than a free market product consumers like Denny should be agonizing over as a consumer… not only for the reasons Peter and Scott mention. America’s current track, even with the ACA, is going to bankrupt the country.

    There are more basic have / have-not questions at stake. As I quote one Canadian who put it quite succinctly: "Do poor children have the right to the same standard of medical care as rich children? Yes or no? Instead, the debate has become about ‘liberties.’ If the consensus answer is ‘No,’ fair enough, continue as is."